Clinical evaluation of CEA, CA19-9, CA72-4 and CA125 in gastric cancer patients with neoadjuvant chemotherapy

Research

Zhipeng Sun and Nengwei Zhang

World Journal of Surgical Oncology 2014, 12:397 
doi:10.1186/1477-7819-12-397

Published: 29 December 2014

Abstract (provisional)

Background

In the clinical practice of neoadjuvant chemotherapy, response markers are very important.
We aimed o investigate whether tumor markers CEA(carcino-embryonic antigen), CA19-9(carbohydrate
antigen 19-9), CA72-4(carbohydrate antigen 72-4), and CA125(carbohydrate antigen 125)
can be used to evaluate the response to neoadjuvant chemotherapy, and to evaluate
the diagnosis and prognosis value of four tumor markers in the patients of gastric
cancer.

Methods

A retrospective review was performed of 184 gastric cancer patients who underwent
a 5-Fu, leucovorin, and oxaliplatin (FOLFOX) neoadjuvant chemotherapy regimen, followed
by surgical treatment. Blood samples for CEA, CA19-9, CA72-4, and CA125 levels were
taken from patients upon admission to the hospital and after neoadjuvant chemotherapy.
Statistical analysis was performed to identify the clinical value of these tumor markers
in predicting the survival and the response to neoadjuvant chemotherapy.

Results

Median overall survival times of pretreatment CA19-9-positive and CA72-4-positive
patients (14.0 +/-2.8 months and 14.8 +/-4.0 months, respectively) were significantly
less than negative patients (32.5 +/-8.9 months and 34.0 +/-10.1 months, respectively)
(P = 0.000 and P = 0.002, respectively). Pretreatment status of CA19-9 and CA72-4
were independent prognostic factors in gastric cancer patients (P = 0.029 and P =
0.008, respectively). Pretreatment CEA 50 ng/ml had a positive prediction value for
clinical disease progression after neoadjuvant chemotherapy according to the ROC curve
(AUC: 0.694, 95% CI: 0.517 to 0.871, P = 0.017). The decrease of tumor markers CEA,
CA72-4, and CA125 was significant after neoadjuvant chemotherapy (P = 0.030, P = 0.010,
and P = 0.009, respectively), especially in patients with disease control (including
complete, partial clinical response, and stable disease) (P = 0.012, P = 0.020, and
P = 0.025, respectively). A decrease in CA72-4 by more than 70% had a positive prediction
value for pathologic response to neoadjuvant chemotherapy according to the ROC curve
(AUC: 0.764, 95% CI: 0.584 to 0.945, P = 0.020).

Conclusions

Our results suggest that high preoperative serum levels of CA72-4 and CA19-9 are associated
with higher risk of death, high pretreatment CEA levels (50 ng/ml) may predict clinical
disease progression after neoadjuvant chemotherapy, and a decrease (70%) of CA72-4
may predict pathologic response to neoadjuvant chemotherapy.